Provider Demographics
NPI:1295930188
Name:HOROWITZ, EVALYN (MD)
Entity type:Individual
Prefix:DR
First Name:EVALYN
Middle Name:
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVALYN
Other - Middle Name:HOROWITZ
Other - Last Name:SPITZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-0956
Mailing Address - Country:US
Mailing Address - Phone:916-689-2053
Mailing Address - Fax:916-689-2053
Practice Address - Street 1:4001 CALIFORNIA 104
Practice Address - Street 2:
Practice Address - City:IONE
Practice Address - State:CA
Practice Address - Zip Code:95640
Practice Address - Country:US
Practice Address - Phone:209-274-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36876207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAH7054240OtherDEA NUMBER